Long term care policies for older populations in new EU member states and Coratia: challenges and oportunities

Experience from OECD countries shows long term care (LTC) for the elderly is expensive and generates financial burden for individuals and households.  The increasing “good practice” in OECD countries is to promote a policy of universal coverage. But given the growing size of the older population and growing dependency ratios, the key policy challenge facing new EU member states and Croatia is how to balance fair financing (where those in need are able to afford LTC) with fiscal sustainability.

This Summary Report, and it's accompanying case studies on Bulgaria, Latvia, Croatia and Poland highlight the main lessons learned from OECD countries with advanced LTC policies and the implications for LTC policymaking in new EU member states and Croatia. It examines the main findings from the Framework Report on the financing, provision and regulation of LTC services, presents comparative findings from the four case study countries, and identifies policy directions for them.

There has been a limited role for the private and NGO sector in the provision of LTC services.

Conclusions from the Case Study Countries:

• strong growth in home- and community-based services has helped cope with the growing number of elderly who need assistance with the activities of daily living
• fragmentation of services between the health and social service sectors can be seen in the types of benefits, eligibility criteria, and provision of benefits. It is also one of the main causes of the systematic lack of reliable data on LTC expenditures
• generally low levels of financing for LTC will have spill-over effects on the sustainability of health financing
• the case study countries lack a coherent strategy and vision for LTC services, although it is important to note there are some incremental reform efforts underway

Future Policy Directions:

• develop a policy for universal LTC financing based on the concept of intergenerational fiscal sustainability. Use actuarial and other financial models to cost out the revenue and expenditure implications of expanding universal LTC coverage. Identify the appropriate LTC package and identify the role of supplemental LTC coverage through other instruments
• do not expand LTC coverage on an inefficient base but use LTC financing to control demand for LTC services and channel toward the right types of services (home-based services, care coordination, convert hospitals into community centers and not LTC institutions)
• think proactively about how to leverage LTC service delivery reforms and encourage private sector provision. This depends a great deal on LTC financing policies and the overall regulatory environment
• develop a strong evidence-base on LTC financing and provision. As a part of developing an LTC policy begin monitoring LTC expenditures and whether LTC expenditures pose a burden on households or how households are coping with increased LTC expenditures during old age. Build a database on coverage of LTC services and trends over time